Case Study (8)- Hemolytic anemia triggered by cold agglutinins
History
A 50-year-old woman complained about acral cyanosis. When exposed to cold her fingers and toes become pale and painful.
Laboratory Investigations:
1. CBC:
RBC:0.81 X 106/μL (4-5.5 X 106/μL)
HGB: 104 g/dL (120-174 g/dL)
HCT: 8% (36-52%)
MCV: 98.6 fL (76–96 fL)
MCH: 128 pg (27-32 pg)
MCHC: 1298 g/L (300-350 g/L)
RDWsd:31.7 fL (20-42 fL)
RDWcv: 10.3% (0-16 %)
WBC: 5.13 X103/ μL (5–10 X 103/ μL)
Neutrophils: 2.83 X 103/μL (2-7.5 X 103/μL)
Lymphocytes: 1.96 X 103/μL (1.08–3.17 X 103/μL)
Monocytes: 0.28 X 103/μL (0.15-0.7 X 103/μL)
Eosinophils: 0.06 X 103/μL (0-0.5 X 103/μL)
Basophils: 0.00 X 103/μL (0-0.15 X 103/μL)
Neutrophils %: 55.1 % (40-75 %)
Lymphocytes %: 38.3 % (14.76-45.4 %)
Monocytes %: 5.4 % (3-7 %)
Eosinophils %: 1.2 % (0-5 %)
Basophils %: 0.0 % (0-1.5 %)
PLT: 225 X 103/μL (150-400 X 103/μL)
Peripheral blood smear
Repeated measurement after pre-warming (37 .C):
RBC:2.82 X 106/μL (4-5.5 X 106/μL)
HGB: 95 g/dL (120-174 g/dL)
HCT: 27.7% (36-52%)
MCV: 98.4 fL (76–96 fL)
MCH: 33.7 pg (27-32 pg)
MCHC: 342 g/L (300-350 g/L)
RDWsd:38.2 fL (20-42 fL)
RDWcv: 11.9% (0-16 %)
WBC: 5.7 X103/ μL (5–10 X 103/ μL)
Neutrophils: 3.93 X 103/μL (2-7.5 X 103/μL)
Lymphocytes: 1.37 X 103/μL (1.08–3.17 X 103/μL)
Monocytes: 0.28 X 103/μL (0.15-0.7 X 103/μL)
Eosinophils: 0.09 X 103/μL (0-0.5 X 103/μL)
Basophils: 0.02 X 103/μL (0-0.15 X 103/μL)
Neutrophils %: 69 % (40-75 %)
Lymphocytes %: 24.1 % (14.76-45.4 %)
Monocytes %: 5 % (3-7 %)
Eosinophils %: 1.5 % (0-5 %)
Basophils %: 0.4 % (0-1.5 %)
PLT: 200 X 103/μL (150-400 X 103/μL)
2. Other laboratory findings
- Marked impairment of hepatic function (associated with heavy drinking).
Diagnosis
Hemolytic anemia triggered by cold agglutinins
Disease course
- The patient was strongly advised to wear protective gloves and socks when the weather is cold.
- Avoidance of alcoholic beverages was also recommended.
- The patient’s immunological assessment did not indicate any autoantibody responsible for hemolysis.
- Hemolytic anemia triggered by cold agglutinins History A 50-year-old woman complained about acral cyanosis. When exposed…){kind=link}
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